Differential Diagnosis Specific differential diagnoses to consider when patients present with ‘tendinopathy’ at various anatomical regions. [physio-pedia.com]

At present, there are many theories that have sought to explain the origin of the pain. [fifamedicalnetwork.com]

Photos of initial, six-week and 12-week presentations demonstrate a relative decrease in the tendon volume. [podiatrytoday.com]

None of the methods presented had particularly awe-inspiring results, and there are numerous other potential treatments backed by equivocal evidence that could have been included in the debate. [runnersworld.com]

Operative intervention should be reserved until conservative measures fail or an obvious operative lesion is present. [onlinelibrary.wiley.com]

• Pain

  Joint-specific tips See the following for ways to ease a specific joint problem: Ankle or heel pain Elbow pain Hip pain Knee pain Shoulder pain Wrist pain References Citations Hurt G, Baker CL (2003). Calcific tendinitis of the shoulder. [healthy.kaiserpermanente.org]

  Pain usually slowly increases with use. [uvahealth.com]

  Pain (lower scores mean less pain) Improved by 28% (ranging from 15% to 42% better) or by 28 points on a scale of zero to 100 points. People who had surgery rated their pain as 12.8 points. [cochrane.org]

• Weakness

  \ ˌten-də-ˈnä-pə-thē \ variants: or less commonly tendonopathy Definition of tendinopathy : injury to a tendon (as from acute trauma or chronic overuse) that is often accompanied by pain, weakness, inflammation, or stiffness especially : a chronic progressive [merriam-webster.com]

  Weakness of the shoulder that increases gradually over time (usually along with the aforementioned pain and soreness). Tenderness/swelling. [coastalorthoteam.com]

  History and Symptoms : Tendinopathy often causes pain, inflammation, stiffness and weakness in the affected area. Physical Exam : A physician will feel the area to check for pain and tenderness. [aapmr.org]

  The "winner" of the debate was the exercise program, because pretty much everyone agreed that it's the first thing to try, and you ultimately need to address whatever weakness is present to get a long-term solution. [runnersworld.com]

• Asymptomatic

  […] thickening, contour change, echotexture change progressive changes: further tendon thickening, loss of normal fibrillary pattern with hypoechogenicity may be focal or diffuse color Doppler may demonstrate neovascularity The above changes can be seen in asymptomatic [radiopaedia.org]

  The risk of tendinopathy increases in patients on insulin and with diabetes duration (mean 5.3 years). 1 Indeed, screening of older patients with type 2 diabetes by ultrasound found 36.8% had asymptomatic Achilles tendinopathy. 4 Other soft-tissue conditions [bjgp.org]

  J Anat 210(1):1–7 Fredberg U, Bolvig L, Andersen NT (2008) Prophylactic training in asymptomatic soccer players with ultrasonographic abnormalities in Achilles and patellar tendons: the Danish Super League Study. [jeo-esska.springeropen.com]

  Asymptomatic tendon degeneration is common and should be considered when performing any investigation on the Achilles tendon. [intechopen.com]

  The rotator cuff is commonly involved and also noted to have more MRI documented degenerative changes on the dominant side of overhead athletes than the non-dominant side, even when asymptomatic. [aspetar.com]

• Falling

  Shoulder tendons are overused most often with: Repeated reaching overhead Repeated throwing Shoulder tendinopathy may also be caused by: Inflammation disease in the shoulder such as arthritis Trauma to the shoulder or fall on outstretched arms. [uvahealth.com]

  Shoulder tendons are overused most often with: Repeated reaching overhead Repeated throwing Shoulder tendinopathy may also be caused by injury to the tendon from: Inflammatory disease in the shoulder, such as arthritis Trauma to the shoulder such as a fall [winchesterhospital.org]

  It’s most often caused by what’s called an extrinsic factor—a force or factor outside the tendon itself, such as a blow, a collision, a fall, a movement (like a sudden overstretching or compression of the tendon), or friction with, or crowding from, another [coastalorthoteam.com]

• Severe Pain

  This usually eases after a few minutes of walking in many cases Variable pain – some people only report a mild ache which eases with exercise. Other people can experience very severe pain which will limit their walking. [nwbh.nhs.uk]

  […] to decrease inflammation Persistent or severe pain may need further treatment. [uvahealth.com]

  Options may include: Nonsteroidal anti-inflammatory drugs (NSAIDs) Topical pain medications that are applied to the skin Persistent or severe pain may need steroid medication. The medication is injected directly to the area. [winchesterhospital.org]

  The indications for using corticosteroid injections are generally for decreasing severe pain to allow the patient to perform exercise rehabilitation relatively pain free, or when there is a plateau in any improvement with exercise rehabilitation. [intechopen.com]

• Shoulder Pain

  Tendinopathy may cause: Pain (a dull ache) in the shoulder and upper arm Pain at night, especially when sleeping on the injured side Pain when trying to reach for a back zipper or pocket Pain with overhead use of the arm Shoulder weakness, usually due [uvahealth.com]

  Common signs of shoulder tendinopathy include: Pain (a dull ache) in the shoulder and upper arm Pain at night, especially when sleeping on the injured side Pain when trying to reach for a back zipper or pocket Pain with overhead use of the arm Shoulder [winchesterhospital.org]

  Painful shoulder syndromes: diagnosis and management. J Gen Intern Med. 1992 May-Jun. 7(3):328-39. [Medline]. Larson HM, O'Connor FG, Nirschl RP. Shoulder pain: the role of diagnostic injections. Am Fam Physician. 1996 Apr. 53(5):1637-47. [Medline]. [emedicine.medscape.com]

  The bottom line: if you have chronic, gradually increasing shoulder pain or limited shoulder movement, don’t put off a visit to the doctor. [coastalorthoteam.com]

  See the following articles for some exercise ideas that will allow you to train while rehabbing: Back Friendly Leg Strength Squat Variations to Fix Your Problem Areas Scaling the Overhead Press Training with Shoulder Pain. [thebarbellphysio.com]

• Elbow Pain

  The elbow was the most common site of injury (20% of all injuries), while the shoulder was the second most common with 15% of all injuries. Other studies have found a 50% lifetime incidence of elbow pain in adult tennis players over 30 years old 4. [aspetar.com]

  Joint-specific tips See the following for ways to ease a specific joint problem: Ankle or heel pain Elbow pain Hip pain Knee pain Shoulder pain Wrist pain References Citations Hurt G, Baker CL (2003). Calcific tendinitis of the shoulder. [healthy.kaiserpermanente.org]

  So you go to your health care provider with a history of “outside elbow pain.” What type of treatments might you get? Anti-inflammatory, maybe a cortisone injection. [caringmedical.com]

• Fracture

  With the strength of tendons at times exceeding the strength of bone, injuries such as fifth metatarsal styloid process avulsion fractures may occur. Tendons may become injured when repeated loads exceed their strength capacity. [drpribut.com]

  Because many shoulder issues share similar symptoms (among them, muscle weakness, fractures, frozen shoulder, shoulder impingement, torn rotator cuffs, and SLAP lesion tears ), it’s important to see an orthopedist or physical therapist for proper testing [coastalorthoteam.com]

  Differential Diagnosis of Posterior Ankle/ Heel Pain Bony Fracture: os trigonum calcaneal stress fracture Severe’s disease (adolescent patients) Joint Tarsal coalition Soft-tissue Impingement syndromes posterior ankle impingement tarsal tunnel syndrome [intechopen.com]

• Back Pain

  Here are 4 Treatments for Chronic Back Pain Worth Discussing With Your Doctor ! Reader Interactions [readersdigest.ca]

  Patrick M Foye, MD Director of Coccyx Pain Center, Professor of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital Patrick M Foye, MD [emedicine.medscape.com]

• Osteophyte

  The formation of excess calcium deposits—bony growths called bone spurs or osteophytes—on the bones of shoulder can similarly lead to friction and crowding, which can irritate or tear a tendon. [coastalorthoteam.com]

Further workup with MRI is also an option to rule out other pathology or determine the severity of the tendinosis. However, it often does not impact the initial treatment. Accordingly, one should reserve MRI for recalcitrant cases. [podiatrytoday.com]

Workup In patients with biceps tendinopathy, plain radiography may show calcifications in the biceps tendon or demonstrate associated degeneration in the glenohumeral or acromioclavicular joint. [emedicine.medscape.com]

Surgical treatment is preferred for chronic and recurring ruptures. [ebm-guidelines.com]

A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. (2011) This article reviews multiple publications regarding the role of Platelet-rich plasma in treatment of tendon and ligament [prolotherapy.com]

Heavy-load eccentric calf muscle training for the treatment of chronic achilles tendinosis. Am J Sports Med. 1998;26(3):360-366. Visnes H, Bahr R. [fifamedicalnetwork.com]

A majority of in vivo studies have documented the effectiveness of ultrasound treatment. [physio-pedia.com]

Reactive Tendinopathy Normal tissue adaptation phase Prognosis: Excellent. Normal Recovery! 2. Tendon Dysrepair Injury rate > Repair rate Prognosis: Good. The tendon tissue is attempting to heal. [physioworks.com.au]

Reactive Tendinopathy Normal tissue adaptation response to decrease stress Acute pain with thickened tendon due to swelling Prognosis: Excellent 2. Tendon Dysrepair Injury rate exceeds Repair rate Prognosis: Good. [rehab2perform.com]

What is the prognosis? Although tendinopathy may seem like relatively benign soft tissue pathology, recovery often follows a prolonged time course, even with ideal treatment. [cmaj.ca]

Long-term prognosis of patients with achilles tendinopathy. An observational 8-year follow-up study. Am J Sports Med 2000;28(5):634-42. «PMID: 11032217» PubMed [ebm-guidelines.com]

[…] tendon (a commonly affected tendon) Specialty Primary care Symptoms Pain, swelling [3] Causes Injury, repetitive activities [3] Diagnostic method Based on symptoms, examination, medical imaging [4] Treatment Rest, NSAIDs, splinting, physiotherapy [5] Prognosis [en.wikipedia.org]

Etiology Overuse or overload injury (repetitive, excessive strain), degeneration Skeletal abnormalities with strain on tendons (e.g., genu varum ) Acute trauma (laceration, rupture) Risk factors Occupation: athletes, jobs requiring manual labor or repetitive [amboss.com]

On the nature and etiology of chronic achilles tendinopathy. Lund University, Sweden; 1997. [ Links ] 3. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. [scielo.isciii.es]

Three etiologies of tendinopathy have been described, as follows [14] : Mechanical theory - This theory states that repetitive loading of the tendon results in microscopic degeneration. Fibroplasia occurs within the tendon, resulting in scar tissue. [emedicine.medscape.com]

However, a low metabolic rate results in slow healing after injury. [6] Epidemiology /Etiology Tendinopathic tendons have an increased rate of matrix remodeling, leading to a mechanically less stable tendon that is probably more susceptible to damage. [physio-pedia.com]

Table 1: Classification of disorders of the Achilles tendon, with typical findings 3, 4 The high prevalence among runners points to mechanical loading as an important etiologic factor. 2 In vitro and in vivo research suggests that periods of mechanical [cmaj.ca]

Epidemiology References: [1] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Types and epidemiology of tendinopathy. N. Maffulli, J. Wong, L. C. Almekinders, Clin Sports Med 22 (2003) 675 – 692. [passeportsante.net]

EPIDEMIOLOGY As tendinopathy is degenerative and cumulative, it rarely occurs in players younger than 18 years old. [aspetar.com]

Epidemiology of tendon problems in sport. In: Maffulli N, Renström P, Leadbetter W, eds. Tendon injuries: Basic science and clinical medicine. London: Springer-Verlag London Limited. Cook JL, Khan KM, Purdam C. Achilles tendinopathy. [fifamedicalnetwork.com]

"Epidemiology of rotator cuff tendinopathy: a systematic review". Shoulder & Elbow. 5 (4): 256–265. doi : 10.1111/sae.12028. ISSN 1758-5740. ^ "Inflammation". The Free Dictionary. ^ "avascular". The Free Dictionary. ^ Rees, J. [en.wikipedia.org]

The pathophysiology of tendinopathy is yet to full elucidated but one popular theory is the continuum model with inflammation rather than degeneration implicated 2,3 : reactive tendinopathy tendon dysrepair (also known as "failed healing") degenerative [radiopaedia.org]

[…] involving the same muscle Errors in physical training (e.g., sudden increase in exercise intensity, inadequate rest, hard/uneven training grounds, ill-fitting /inappropriate footwear) Previous tendon injuries Recent use of fluoroquinolones References: [1] Pathophysiology [amboss.com]

The Pain of Tendinopathy: Physiological or Pathophysiological. Sports Med 2014. 44:9-23. 4 Scott A, Docking S, Vicenzino B, et al. [acatoday.org]

"Enthesitis: from pathophysiology to treatment". Nature Reviews Rheumatology (Review). 13 (12): 731–741. doi : 10.1038/nrrheum.2017.188. PMID 29158573. ^ Schmitt, SK (June 2017). "Reactive Arthritis". [en.wikipedia.org]

[…] structure through tenolysis) is rarely necessary but may be required in refractory cases. [7, 8, 9, 10, 11] Related Medscape Reference topics: Bicipital Tendon Injuries Bicipital Tendonitis Elbow and Forearm Overuse Injuries Shoulder Impingement Syndrome Pathophysiology [emedicine.medscape.com]

Making sure to perform a proper warm-up and including enough cross-training is also helpful to prevent tendon overuse injuries. [verywellhealth.com]

This will prevent stiffness in your joint. As the pain goes away, continue range-of-motion exercises and add other exercises to strengthen the muscles around your joint. [healthy.kaiserpermanente.org]

It is vital that you prevent deterioration and progression to permanent cell death (phase 3). 3. Degenerative Tendinopathy Cell death occurs Prognosis: Poor! Tendon cells are dying! 4. [physioworks.com.au]